OASIS Alert
Muscle Weakness Coding Draws Intermediary Scrutiny
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Don't fall for 728.2.
If you don't know the difference between the 728.x diagnosis codes and the 780.x codes when you answer M0230, expect to see downcoded claims galore.
ICD-9 codes 728.2 (Muscular wasting and disuse atrophy, not elsewhere classified) and 728.9 (Unspecified disorder of muscle, ligament, and fascia) are attracting attention - and downcodes - from medical reviewers at regional home health intermediary Cahaba GBA, the RHHI's June newsletter says.
The 728.2 code includes the diagnoses "Amyotrophia NOS" and "Myofibrosis" and can be used as a primary diagnosis if one of these conditions is the main focus of home care, Cahaba instructs.
"Many home health agencies are reporting 728.2 to code muscular weakness resulting from a temporary decrease, or non-use of a group of muscles, such as weakness resulting from a hospitalization," Cahaba reports. Instead, use a code from the 780.7 group "malaise and fatigue," the RHHI suggests.
Note: For instructions in using these codes appropriately, go to www.iamedicare.com/Provider/newsroom/newslines/0605.pdf.
On page three of ELGA find the provider number - in the PROV NUM field. Next, look in the INTER NUM field for the contractor number of the RHHI that processed the overlapping claim. Then, call the RHHI for contact information you need to contact the other HHA.
The RHHI codes and phone numbers are: Anthem (00180) 877-498-1351, Palmetto (00380) 877-272-5786, United Government Services (00450) 877-309-4290, United Government Services (California) (00454) 866-380-4745 and Cahaba GBA (00011) 877-299-4500.
"NAHC is urging all agencies that receive the survey to take the time to research the information requested and complete it," the trade group says. Survey findings will go into a congressional report on whether OASIS data should be collected for non-Medicare, non-Medicaid patients.
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Muscle Weakness Coding Draws Intermediary Scrutiny
Don't fall for 728.2.
If you don't know the difference between the 728.x diagnosis codes and [...]